Comatose state and cases of prolonged stay in it. Reference. How long can a person remain in a coma? Can people come out of a stage 4 coma?

From ancient Greek “coma” is translated as “deep sleep”. While a person is in a coma, the nervous system is depressed. This is very dangerous, because this process progresses and failure of vital organs is possible, for example, respiratory activity may stop. While in a coma, a person stops responding to external stimuli and the world around him; he may have no reflexes.

Prekoma. While in this state, the person remains conscious, but there is slight confusion in actions and lack of coordination. The body functions according to the concomitant disease.
Coma 1st degree. The body's reaction is very inhibited even to strong stimuli. It is difficult to find contact with the patient, but he can make simple movements, for example, turning over in bed. Reflexes are preserved, but are very weakly expressed.
Coma 2nd degree. The patient is in a deep stage of sleep. Movements are possible, but they are performed spontaneously and in a chaotic manner. The patient does not feel touch, the pupils do not react to light in any way, and respiratory function is impaired.
Coma 3rd degree. Deep coma. The patient does not respond to pain, the reaction of the pupils to light is completely absent, reflexes are not observed, the temperature is low. Disturbances occur in all body systems.
Coma 4 degrees. A state from which it is no longer possible to get out. The person has no reflexes, the pupils are dilated, and the body is hypothermic. The patient cannot breathe on his own.

In this article we will take a closer look at the condition of a person in a penultimate degree coma.

Coma 3rd degree. Chances of survival

This is a very dangerous condition for human life, in which the body cannot practically function independently. Therefore, it is impossible to predict how long the unconscious state will last. It all depends on the body itself, on the degree of brain damage, and on the age of the person. Coming out of a coma is quite difficult; as a rule, only about 4% of people are able to overcome this barrier. Moreover, even if the person has regained consciousness, most likely he will remain disabled.

If you are in a third-degree coma and return to consciousness, the recovery process will be very long, especially after such serious complications. As a rule, people learn to speak, sit, read, and walk again. The rehabilitation period can take quite a long time: from several months to several years.

According to studies, if in the first 24 hours after the onset of a coma a person does not feel external irritants and pain, and the pupils do not react to light in any way, then such a patient will die. However, if at least one reaction is present, then the prognosis is more favorable for recovery. It is worth noting that the health of all organs and the age of the patient who has developed a 3rd degree coma play a huge role.

Chances of survival after an accident

About thirty thousand people a year die as a result of road accidents and three hundred thousand become their victims. Many of them become disabled as a result. One of the most common consequences of a road accident is traumatic brain injury, which often causes a person to fall into a coma.

If, after an accident, a person’s life requires hardware support, and the patient himself has no reflexes and does not respond to pain and other stimuli, a 3rd degree coma is diagnosed. The chances of survival after an accident that leads to this condition are negligible. The prognosis for such patients is disappointing, but there is still a chance of returning to life. It all depends on the degree of brain injury as a result of the accident.

If a stage 3 coma is diagnosed, the chances of survival depend on the following factors:

Degree of brain injury.
Long-term consequences of TBI.
Fracture of the base of the skull.
Fracture of the cranial vault.
Fracture of the temporal bones.
Concussion.
Trauma to blood vessels.
Brain swelling.

Probability of survival after a stroke

A stroke is a disruption of the blood supply to the brain. It happens for two reasons. The first is blockage of blood vessels in the brain, the second is bleeding in the brain.

One of the consequences of cerebrovascular accident is coma (apoplectiform coma). In case of hemorrhage, a 3rd degree coma may occur. The chances of surviving a stroke are directly related to age and the extent of the damage. Signs of this condition:

Lack of consciousness.
Change in complexion (becomes purple).
Loud breathing.
Vomit.
Trouble swallowing.
Slowing heart rate.
Increased blood pressure.

The duration of the coma depends on a number of factors:

Coma stage. In the first or second stage, the chances of recovery are very high. With the third or fourth, the outcome is usually unfavorable.
Condition of the body.
Patient's age.
Equipping with necessary equipment.
Patient care.

Signs of third degree coma during stroke

This condition has its own distinctive features:

Lack of response to pain.
The pupils do not respond to light stimuli.
Lack of swallowing reflex.
Lack of muscle tone.
Reduced body temperature.
Inability to breathe independently.
Bowel movements occur uncontrollably.
Presence of seizures.

As a rule, the prognosis for recovery from a third-degree coma is unfavorable due to the absence of vital signs.

Probability of survival after neonatal coma

A child may fall into a coma in the event of a deep disorder of the central nervous system, which is accompanied by loss of consciousness. The reasons for the development of coma in a child are the following pathological conditions: renal and liver failure, meningoencephalitis, brain tumor and trauma, diabetes mellitus, water and electrolyte imbalance, cerebral hemorrhage, hypoxia during childbirth and hypovolemia.

Newborns fall into a comatose state much more easily. It is very scary when a third degree coma is diagnosed. A child has a higher chance of survival than older people. This is explained by the characteristics of the child’s body.

In the case when a 3rd degree coma occurs, the newborn has a chance of survival, but, unfortunately, it is very small. If the baby manages to get out of a serious condition, severe complications or disability are possible. At the same time, we must not forget about the percentage of children, albeit small, who managed to cope with this without any consequences.

Consequences of coma

The longer the unconscious state lasts, the more difficult it will be to get out of it and recover. A 3rd degree coma can occur differently for everyone. The consequences, as a rule, depend on the degree of brain damage, the length of time spent in an unconscious state, the reasons that led to the coma, the health of the organs and age. The younger the body, the higher the chances of a favorable outcome. However, doctors rarely make a prognosis for recovery, since such patients are very sick.

Despite the fact that newborns recover from a coma more easily, the consequences can be very sad. Doctors immediately warn relatives how dangerous a 3rd degree coma is. Of course, there are chances of survival, but at the same time a person may remain a “plant” and never learn to swallow, blink, sit and walk.

For an adult, a prolonged stay in a coma is fraught with the development of amnesia, the inability to move and speak, eat and defecate independently. Rehabilitation after a deep coma can take from a week to several years. In this case, recovery may never occur, and the person will remain in a vegetative state for the rest of his life, when he can only sleep and breathe independently, without reacting in any way to what is happening.

Statistics show that the chance of a full recovery is extremely small, but such events do happen. Most often, death is possible, or in case of recovery from a coma - a severe form of disability.

Complications

The main complication after a coma is a violation of the regulatory functions of the central nervous system. Subsequently, vomiting often occurs, which can enter the respiratory tract, and stagnation of urine, which can lead to bladder rupture. Complications also affect the brain. Coma often leads to breathing problems, pulmonary edema and cardiac arrest. Often these complications lead to biological death.

The feasibility of maintaining body functions

Modern medicine makes it possible to artificially maintain the vital functions of the body for quite a long time, but the question often arises about the feasibility of these measures. This dilemma arises for relatives when they are informed that the brain cells have died, that is, in fact, the person himself. Often a decision is made to remove artificial life support.

The problem of coma today has gone beyond the scope of medicine. Is it worth supporting the life of a person who cannot communicate with the outside world? How to determine how deep he has “gone”, does he hear what is happening around him, does he experience emotions, or is he in a “vegetative” state in which he can no longer be helped?

Read also: Ten signs that death is near

Deep sleep, nap

To talk on this topic, of course, we first need to tell in more detail what a comatose state actually is, what its reasons, duration, in what cases there is hope for recovery from coma, and in some - not. The topic of hope for recovery is especially important to us, because today views on its criteria are changing.

So, coma(Greek koma - deep sleep, drowsiness) is a life-threatening condition in which a person loses consciousness, shows little or no reaction to external stimuli. His reflexes fade away until they disappear completely, the depth and frequency of breathing is disrupted, vascular tone changes, the pulse quickens or slows down, and temperature regulation is disrupted.

Read also: Diabetic coma. First aid

As a rule, coma is preceded by the so-called precomatose state, during which a person develops symptoms of deep inhibition in the cerebral cortex, and at the same time there are disturbances in the acid-base balance in the nervous tissue, oxygen starvation, ion exchange disorders and energy starvation of nerve cells.

Insidiousness comatose state the fact that it can last only a few hours, or maybe several months, and even years. It is the duration of a coma that differs from fainting, which usually lasts several minutes.

It is often quite difficult for doctors to find out cause of coma. As a rule, it is judged by the rate of development of the disease. For example, a coma suddenly develops after acute vascular disorders of the brain, but the gradual “fading” of a person is characteristic of infectious lesions; the symptoms of a coma grow even more slowly with endogenous (internal) intoxications such as diabetes, kidney disease, and liver disease.

For doctors treating people who have fallen into coma, there are a lot of nuances by which they determine an accurate diagnosis “ coma". After all, there are other conditions with similar symptoms. For example, “locked-in syndrome,” when a person cannot respond to external stimuli due to paralysis of the bulbar, facial and masticatory muscles, which usually occurs due to damage to a brain structure such as the base of the pons. The patient can only move the eyeballs, while being fully conscious.

Not all patients, alas, come out of coma. Sometimes, if this condition drags on and the brain damage is so severe that there is no hope for recovery, doctors, together with the patient’s relatives, decide on the issue of disconnecting him from life support systems. Sometimes a person comes out of a coma, but falls into a so-called chronic vegetative state, in which only wakefulness is restored, and all cognitive functions are lost. He sleeps and wakes up, breathes on his own, his heart and other organs function normally, but at the same time he lacks movement, speech and reaction to verbal stimuli. This condition can last for months or even years, but the prognosis is unfavorable - as a rule, the patient eventually dies from infections or bedsores. The cause of the vegetative state is a massive lesion of the forebrain, often in the complete death of the cerebral cortex. This condition also serves as a reason to turn off the devices.

It must be said that history knows a lot and happy examples of a person coming out of a long coma and in some cases even returning him to normal life. Although most of these cases occurred not in Russia, but abroad.

Matveev Kirill

One of the most mysterious human conditions. Is he alive or dead, can he hear us? What should you do if you have to decide to turn off life support?

Still from the film “Talk to Her” by Piedro Almodovar (2002)

Movies lie

In May 2006, the journal Neurology published an article by the American doctor E. Wijdix entitled “Depiction of coma in modern feature films.” A very unexpected topic for a serious medical journal that publishes the results of scientific research in the field of human brain activity and its diseases.

It is clear that viewers do not expect complete life truth from a film, even a realistic one; film critics do not evaluate a work of art by how accurately a medical episode corresponds to the description of the disease in a textbook; what is more important is the symbolic level of the image, a certain global statement of the author. For example, in the film “Talk to Her,” the outstanding Spanish director Pedro Almodovar tells the story of a young talented ballerina who not only awakens after a many-year coma, but also almost completely recovers. At the end of the film, a girl comes to the theater to watch her favorite ballet, leaning only lightly on a cane. Dr. Wijdix harshly criticizes the film for the implausibility of such an outcome, but in fact this is the director’s deeply labored message about the great transformative power of love.

Meanwhile, Dr. Wijdix's concerns are not unfounded. Having analyzed 30 films produced between 1970 and 2004, he came to the conclusion that only in two patients in a coma are shown realistically, in the rest they are beautiful in appearance, like the heroine of the fairy tale “Sleeping Beauty,” and immediately after emerging from a coma they become cheerful and active, and even perform feats, defeating superior enemy forces (as in the American TV series “24 Hours”). Doctors in such films are depicted as caricatures and do not inspire any credibility.

But the most important thing was something else: out of 72 non-medical respondents, 28 viewers, that is, 39%, reported that when making decisions regarding loved ones who find themselves in a coma, they would rely on knowledge gleaned from watching movies. And this is a worrying sign.

It is difficult to say how representative this result is, but it can be assumed with a high probability that the “sleep of reason” is mythologized for most of us, and when we find ourselves in a severe stressful situation, if a misfortune has happened to a person close to us, we do not really know what to expect, but what to hope for and how to act.

What is known about coma

Coma is a state of prolonged absence of consciousness, which is characterized by a sharp weakening or lack of response to external stimuli, extinction of reflexes until they completely disappear, impaired depth and frequency of breathing, changes in vascular tone, increased or slowed pulse, and impaired temperature regulation.

Coma develops as a result of damage to the brain, causing an acute circulatory disorder in it, the consequence of which is deep inhibition in the cortex with its spread to the subcortical parts of the central nervous system.

The causes of coma are varied:

– head injury that leads to brain hemorrhage or swelling;
– a stroke, in which the brain stem is left without blood supply, or a cerebral hemorrhage occurs in combination with edema;
– a sharp increase in blood sugar levels (hyperglycemia) or a sharp decrease (hypoglycemia) in patients with diabetes;
– hypoxia, that is, oxygen starvation caused by drowning, suffocation or cardiac arrest;
– central nervous system infection such as meningitis or encephalitis;
– poisoning by decay products in the body that are not excreted due to failure of excretory systems or organs, for example, ammonia during liver disease, carbon dioxide during a severe attack of asthma, urea during kidney failure;
– epileptic seizures that recur within a short period of time.

There is also such a thing as a medically induced coma. It is induced by doctors in order to protect the body from disorders that negatively affect the activity of the cerebral cortex, such as hemorrhages with compression of the brain and its swelling. Artificial coma is also used instead of anesthesia when a series of complex emergency operations is necessary, during neurosurgical operations, as well as to bring the body out of epileptic status if other methods have proven ineffective.

Coma can develop suddenly or gradually, over a period of several minutes to several hours or even days. There are several classifications of types of coma, both according to its origin and degree of depth. In Russian sources, a gradation of depth from precoma to 4th degree coma is most often found.

In a state of precoma, the patient is either severely inhibited or, conversely, demonstrates psychomotor agitation; with preserved reflexes, coordination of movements is impaired, consciousness is confused.

In a state of 1st degree coma, there is sleep or stupor, marked inhibition of reactions to external stimuli, including pain, but the patient can perform simple movements, swallow water and liquid food, although contact with him is significantly difficult.

Coma of the 2nd degree is a deep sleep, lack of contact, rare spontaneous chaotic movements, pathological forms of breathing, the change of sharp tension in the muscles of the limbs with their relaxation, spastic contractions and fibrillation of individual muscles, weakened reaction of the pupils to light.

In a 3rd degree coma, which is also called atonic, there is no consciousness, no reaction to pain, reflexes are depressed or lost, there is no reaction of the pupils to light, convulsions are possible, breathing is arrhythmic, blood pressure and body temperature are reduced.

Coma 4th degree (extraordinary) is a state of complete absence of reflexes, muscle atony, a sharp decrease in pressure and temperature. The medulla oblongata stops functioning, so spontaneous breathing stops. The patient's condition is maintained using an artificial lung ventilation device (ALV) and parenteral (injection) nutrition. Often, an extreme coma ends in death, but if it is possible to bring the patient out of this state within half an hour and positive dynamics subsequently develop, then in this case, complete or partial restoration of brain function is possible.

During coma, the central nervous system ceases to perform its regulatory function, therefore, the clear interaction of organs and systems is disrupted, the ability to self-regulate and maintain the constancy of the internal environment of the body is reduced.

How is it treated

Treatment for coma depends on the cause that caused it. A complete cure is possible if the patient is provided with medical assistance to eliminate the underlying disorder in a very short time and supportive measures are carried out correctly. So, if the coma is caused by diabetic shock, administration of glucose is necessary; for an infection that has spread to the brain, antibiotics are required; if pressure on the brain due to edema or tumor, surgical intervention is required. Swelling can be treated with medication, and medications are also used to stop seizures.

Supportive measures are necessary for coma, so patients are placed in intensive care units, where life support systems are used until significant improvements occur in the patient’s condition.

The prognosis for coma is highly individual and depends on many factors, the main ones being its cause and duration. If the cause can be eliminated, the person can return to normal life, but with severe brain damage, the patient remains disabled or does not return to consciousness at all.

In case of coma caused by drug poisoning, the patient's chance of full recovery is quite high. Coma caused by traumatic brain injury more often ends in recovery than coma resulting from oxygen deprivation. Rehabilitation of a patient in a diabetic coma is often successful if his blood glucose level is adjusted quickly enough.

If the patient is in a deep coma and does not respond to painful stimuli, then the significant improvement for him will be the appearance of a response to pain. Improvement may continue. Coming out of a coma is considered a state in which the patient can consciously perform some simple action (for example, open his eyes) in response to a doctor’s request.

As a rule, the longer the patient is in a coma, the chances of recovery decrease. Often patients emerge from a coma after many weeks of being in it, but, as a rule, with consequences leading to severe disability.

Modern life support systems are capable of artificially maintaining a person’s biological life for as long as desired, and the issue of disconnecting a patient in a coma from the system is quite complex from an emotional and ethical point of view, both for the patient’s relatives and for doctors. It is important to know that a sufficient basis for such a disconnection is only a statement of brain death, which is regulated by order of the Ministry of Health of the Russian Federation dated December 25, 2014 N908n “On the procedure for establishing the diagnosis of human brain death.”

For family and friends

In addition to feature films, there are many stories, oral and written, about how relatives refused to believe in the hopelessness of a loved one and were rewarded with his subsequent awakening and restoration. Here you need to keep in mind that, as a rule, in such stories there is no documentary data about what exactly doctors understood by the word “hopeless” and whether all 9 signs of brain death were recorded and recorded.

As for recovery after a long coma, in cases of famous people followed by numerous fans, we observe a very slow and far from complete recovery. Miracles did not happen, sadly, neither with Michael Schumacher, nor with Nikolai Karachentsov, who received excellent medical care and care.

For loved ones, however, the very fact that a loved one is alive, provides the opportunity for care and at least limited contact, is often a joy. Here is the story told by a woman who fought for 19 years to restore her son, who was injured in an accident and spent 4 months in a coma. Nathan, 36, remains severely disabled, but his mother is happy that they are together.

And one more inspiring fact for the relatives of patients in a coma.

In January 2015, the journal Neurorehabilitation and Neural Repaire published data from a study of American doctors demonstrating the fact that comatose patients recovered faster and better than other patients in the same condition if they listened to recordings of their family members' stories. about the events of family history known to them. These were the voices of parents, brothers and sisters, whom the patients listened to through headphones. Using magnetic resonance imaging while listening to the recordings, the scientists were able to track increased neural activity in the areas of the patient's brain responsible for language and long-term memory, and after 6 weeks of such stimulation, the patients began to respond better to other external stimuli.

When visiting a patient, tell him who you are; Try to be positive in conversations.
Talk about how your day went, as if the patient understood you.
Keep in mind that everything you say in the presence of the patient may be heard by him.
Show him your love and support, even if just by sitting next to him and holding his hand.
Let him listen to his favorite music through headphones.

Of course, conversations between relatives and patients are not a miracle cure for a complete cure, however, contrary to the fair criticism of Dr. Vidzhdiks, the “Talk to Her” recipe turns out to be effective. And if art proclaims the limitlessness of a person’s ability to awaken another person, dear and loved, to life, then science recognizes our limitations, and nevertheless confirms that feelings and relationships can become the bridge through which our loved ones are able to return to us.

Sources:

Coma, or sleep of the mind

Family Voices and Stories Speed Coma Recovery

Every day new patients are admitted to hospitals in different cities. Sometimes a patient has to make a choice in favor of one treatment or another, or refuse it altogether, but what should someone who is in a coma do?

What is a coma and how to bring a person out of it
Are there coma qualifications?
How do you get out of it?
Are there any consequences?
How to come out of a coma
Deep sleep, nap
Other coma-like conditions
Coming out of a coma and further prognosis
Happy examples of coming out of a coma
New opportunities for contact with a person in a coma
Coma is one of the most mysterious conditions
After a coma - a different personality
Inner life
Miraculous return
RELATED POSTS
Add a comment Cancel reply
Change text size
Favorites
Money conspiracy. The most powerful conspiracies
Prophecies about Russia
World War III - ominous predictions
Pavel Globa predictions for 20 years - Horror
Subscribe to video
Coming out of a coma after a stroke
Why and under what circumstances does coma develop during a stroke?
Content
Features of coma symptoms after a stroke
How to care for a patient in a coma
The process of a patient coming out of a coma
Coma after stroke
What is coma?
What exactly is a coma?
Other states of consciousness
How do people fall into a coma?
Medically induced coma
How can you tell if someone is in a coma?
"Soap Opera Coma"
How do doctors “treat” patients in a coma?
Difficult decision
How do people “come out” of a coma?
Amazing awakenings

People in deep sleep cannot make decisions and therefore this heavy responsibility falls on the shoulders of their immediate family. To understand what to do in such a situation, you need to know what a coma is, how you can bring a person out of it and what its consequences are. Let's talk about this.

What is a coma and why can people enter this state?

Coma refers to a severe comatose state in which a person is plunged into deep sleep. Depending on the degree of coma the patient has, various functions of the body may be slowed down, brain activity may be disabled, metabolism and the functioning of the nervous system may be completely stopped or significantly slowed down.

The cause may be: stroke, brain injury, meningitis, epilepsy, encephalitis, hypothermia or overheating of the body.

Are there coma qualifications?

Coma is conventionally divided into 5 degrees of severity, namely:

1st degree - precoma. Those affected by this gradually begin to experience general lethargy, a drop in reaction, a feeling of drowsiness, lack of sleep, and confusion in consciousness. It’s rare, but it still happens that everything happens the other way around, in excessive excitement. Reflexes at this stage are preserved, while the work of all internal organs is already inhibited. Sometimes precoma is called nothing more than a state before a coma, and is not referred to as a coma at all.
Grade 2 - initial level of severity. Reactions to external stimuli begin to slow down. The person still has the ability to swallow liquid food and water, he can move his limbs, but only slightly.
Grade 3 - moderate level of severity. The patient is already entering a state of deep sleep, contact with him becomes impossible. Only sometimes movements of the limbs can be observed, but rarely they are conscious. The skin already has low sensitivity, a person walks under himself.
Grade 4 - high level of severity. There is a lack of feeling of pain, consciousness, tendon reflexes, and no reaction to light. Not only body temperature is reduced, but also breathing pressure.
Stage 5 – severe coma. The disturbance of consciousness becomes profound, reflexes are absent. Breathing stops and the patient is transferred to an artificial respiration apparatus.

What are the signs to recognize someone?

Only specialists can recognize who it is. For these purposes they conduct the following research:

The level of alcohol in the blood is determined to exclude alcohol intoxication, which may temporarily turn off consciousness.
The presence of drugs in the blood is determined to exclude drug-induced fainting.
An electrocardiogram is performed.

These are only general studies; special ones can be prescribed by doctors if necessary.

How long can a person stay in a coma?

Doctors still cannot answer the question of how long people can remain in a coma. The thing is that history knows of cases when, after 12 years, people managed to get out of a coma. This is purely individual and one person can come out of this state in just three days, while others will spend years of their life in it.

How does a person feel while in a coma?

The reactions have already been mentioned earlier; depending on the severity, a person may or may not feel touch. All people who have experienced coma claim that they heard everything that was happening around them, but could not understand whether it was a dream or reality.

Doctors also claim that when relatives often communicate with patients in a coma, they begin to experience active activity in the part of the brain responsible for facial recognition. Also, active impulses appear in the centers responsible for emotions.

Someone claims to have met with deceased relatives; all this happens in patients in a state of sleep, in which, as we know, anything can happen.

How can you bring a person out of a coma?

Unfortunately, today there is no answer to the question that interests everyone, “how to bring a loved one out of a coma.” All that doctors advise is to talk to the person, hold his hand, let him listen to music, read books. Sometimes a sound or phrase helps a person, grasping it like a thread, come out of a comatose state.

How do you get out of it?

Coming out of a coma occurs gradually. At first, a person may wake up for a couple of minutes, look around and fall back asleep. An hour or two will pass and he will wake up again, and this happens several times.

At this moment, a person will need the help of loved ones more than ever, everything around will be foreign to him and it will be like a child starting to learn to walk and talk again.

Are there any consequences?

Due to the fact that a comatose state is characterized by brain damage, you need to understand that it will take time to restore some functions. For rehabilitation, special developmental simulators will be required.

Immediate consequences include memory problems, even amnesia. Lethargy, absent-mindedness, and aggressiveness may appear. Don't be afraid, all this can be restored, you just need time and patience. A person may have lost everyday skills, so he will need to be taught everything again. It is easy to understand what consequences await those who have spent more than five years in a coma; during this time, a lot has changed around them and then the person needs to be introduced to everything around him.

A coma is certainly scary, but if your loved ones find themselves in it, you don’t need to give up, because people come out of it, and then begin to live their old lives again, even if not immediately.

Source: coming out of a coma

Considering that the possibility of euthanasia (voluntary death of incurable patients) is widely discussed in the world today, and in some countries it has already been resolved, the issue of distinguishing between such conditions in order to determine the hopelessness of the patient or the presence of prospects for cure is of particular importance.

Deep sleep, nap

To talk on this topic, of course, you first need to tell in more detail what a comatose state actually is, what are its causes, duration, in which cases there is hope for exiting the coma, and in which there is not. The topic of hope for recovery is especially important to us, because today views on its criteria are changing.

So, coma (Greek koma - deep sleep, drowsiness) is a life-threatening condition in which a person loses consciousness, shows little or no reaction at all to external stimuli. His reflexes fade away until they disappear completely, the depth and frequency of breathing is disrupted, vascular tone changes, the pulse quickens or slows down, and temperature regulation is disrupted.

The causes of this condition may be different, but they all lead to deep inhibition in the cerebral cortex, spreading to the subcortex and underlying parts of the central nervous system. This can occur as a result of acute circulatory disorders in the brain, head injuries, any inflammation (encephalitis, meningitis, malaria), as a result of poisoning (barbiturates, carbon monoxide, etc.), as well as diabetes, uremia, hepatitis.

As a rule, coma is preceded by a so-called precomatose state, during which a person develops symptoms of deep inhibition in the cerebral cortex, and along the way, disturbances in the acid-base balance in the nervous tissue, oxygen starvation, ion exchange disorders and energy starvation of nerve cells occur.

The insidiousness of a comatose state is that it can last only a few hours, or maybe several months, and even years. It is the duration of a coma that differs from fainting, which usually lasts several minutes.

It is often quite difficult for doctors to figure out the cause of a coma. As a rule, it is judged by the rate of development of the disease. For example, a coma suddenly develops after acute vascular disorders of the brain, but the gradual “fading” of a person is characteristic of infectious lesions; the symptoms of a coma grow even more slowly with endogenous (internal) intoxications such as diabetes, kidney disease, and liver disease.

For doctors dealing with people who have fallen into a comatose state, there are a lot of nuances by which they determine the exact diagnosis of “coma”. After all, there are other conditions with similar symptoms. For example, “locked-in syndrome,” when a person cannot respond to external stimuli due to paralysis of the bulbar, facial and masticatory muscles, which usually occurs due to damage to a brain structure such as the base of the pons. The patient can only move the eyeballs, while being fully conscious.

In turn, such patients are similar to patients with akinetic mutism, who are also conscious and are able to follow moving objects with their eyes, but cannot move due to organic lesions (trauma, vascular accidents, tumors) of some parts of the brain. Thus, until now, one of the differences between these diagnoses and coma is considered to be the presence of consciousness. But today these criteria may be shaken, and below we will explain why.

Coming out of a coma and further prognosis

Not all patients, alas, come out of a coma. Sometimes, if this condition drags on and the brain damage is so severe that there is no hope for recovery, doctors, together with the patient’s relatives, decide on the issue of disconnecting him from life support systems. Sometimes a person comes out of a coma, but falls into a so-called chronic vegetative state, in which only wakefulness is restored, and all cognitive functions are lost. He sleeps and wakes up, breathes on his own, his heart and other organs function normally, but at the same time he lacks movement, speech and reaction to verbal stimuli. This condition can last for months or even years, but the prognosis is unfavorable - as a rule, the patient eventually dies from infections or bedsores. The cause of the vegetative state is a massive lesion of the forebrain, often in the complete death of the cerebral cortex. This condition also serves as a reason to turn off the devices.

But comatose patients still have a chance. With proper treatment and a favorable prognosis, a person can come out of a coma. The functions of the central nervous system - reflexes, autonomic functions - are gradually restored. What’s interesting is that, as a rule, their restoration occurs in the reverse order of oppression. Often, the restoration of consciousness occurs through confusion and even delirium, accompanied by discoordinated movements and, less commonly, convulsions. Even if a person regains the ability to think, speak and move, then it is very important how properly he was cared for during a coma, because immobility can lead to muscle atrophy and bedsores, which requires additional treatment.

Unfortunately, in Russia today the level of care provided to patients in a coma and vegetative state is not at the proper level. This is the opinion of Sergei Efremenko, a doctor who has been dealing with such patients for many years, the head of the department of resuscitation and intensive care for neurosurgical patients at the N.V. Sklifosovsky Research Institute of Emergency Care. According to him, it is this level that shows, firstly, the moral state of society, and secondly, the level of development of medicine. “Unfortunately,” says Efremenko, “in our country today there is not a single medical institution specialized in the treatment of such patients. In the majority of cases, patients in vegetative states are doomed to a painful death, unable to live to see a possible improvement in their condition, while bringing unbearable suffering to their loved ones.”

Happy examples of coming out of a coma

It must be said that history knows many happy examples of a person emerging from a long coma and, in some cases, even returning to normal life. Although most of these cases occurred not in Russia, but abroad.

For example, in 2003, American Terry Wallis came to his senses after 19 years in a coma, which he fell into after being injured in a car accident. In 2005, American firefighter Don Herbert emerged from a 10-year coma after being trapped without air for 12 minutes. In 2007, Polish citizen Jan Grzebski came to his senses after being in a coma for 18 years. He was injured after being involved in a train accident. Thanks to his wife’s care, he came out of this state without muscle atrophy and bedsores and... learned that now all four of his children were married and that he now has 11 grandchildren. And finally, the Chinese woman Zhao Guihua, who had been in a coma for 30 years, woke up in November 2008. Her husband selflessly stayed by her bedside and, in addition to caring for her, maintained constant verbal contact - telling her about the latest events and speaking kind words of love and support. And, quite possibly, this was precisely what was of key importance - as recent studies have shown, many such patients retain the ability to hear and realize what they heard. And this can radically change the current opinion that a person in a coma is a person who has lost consciousness.

New opportunities for contact with a person in a coma

In general, the problem of coma, without a doubt, requires careful study, because the price of an error here is too high. Turning off life support systems in accordance with the wishes of the patient (in countries where euthanasia is allowed, each person can make such a request in advance) or with the consent of his relatives can take the life of a person who, perhaps, would soon come to his senses. Moreover, the attitude of the majority of people and doctors themselves around the world towards the possibility of euthanasia is negative.

For example, Dr. Efremenko is deeply convinced that the problem of coma and incurable conditions cannot be linked with the problem of euthanasia, since it is contrary to the moral principles of any doctor and opposes the main message of healing “Non nocere” - “do no harm.” “The chance of error, even if it is one millionth of a percent, may also occur,” says the doctor. He recalls that Orthodoxy is the titular religion of our country, and its canons categorically do not accept both murder and suicide. Only God is in charge of our lives, as well as our suffering. However, this also applies to other religions, adds Efremenko.

This complex question is all the more pressing given that recent research has confirmed that 30% of comatose patients actually show signs of consciousness. A new brain-computer interface helped determine this, with the help of which scientists were able to look into the previously inaccessible depths of the brain of an immobilized and seemingly detached person from reality.

The study, organized by the German-Belgian Comatose Study Group under the leadership of Professor Stephen Loris, was built using a computer, a special program of which read the results of the encephalograms of two groups - patients in a comatose state and healthy people from the control group. Encephalograms were obtained when subjects answered simple questions, where everyone had to choose the correct answer using simple words “yes”, “no”, “forward” and “stop”. A real sensation was that three out of ten people who were in a coma answered most of the questions correctly! This meant that doctors today do not know everything about the nuances of this condition, and that in the future they have a chance, through established contact with such patients, not only to make an accurate diagnosis and calculate the chances of recovery, but also to find out from them what they are suffering from. need and are satisfied with care.

The results of this promising study were presented at the annual meeting of the European Neurological Society (ENS) and were highly praised by scientists from different countries.

How do our Russian doctors evaluate such studies? We finally asked Dr. Efremenko about this. “In the study of coma and vegetative states, science is still only on the shores of a vast ocean of knowledge,” he noted. “We haven’t even gotten our feet wet yet.” Only when we have comprehensive and accurate information about coma and vegetative states will we truly be able to make any decisions about the fate of patients.”

IA No. FS77−55373 dated September 17, 2013, issued by the Federal Service for Supervision of Communications, Information Technologies and Mass Communications (Roskomnadzor). Founder: PRAVDA.Ru LLC

Source: - one of the most mysterious conditions

How to get out of a coma and what happens after?

Coma is traditionally considered an intermediate state between life and death: the patient’s brain does not respond to external stimuli, consciousness fades away, only the simplest reflexes remain... Doctors usually advise the relatives of a comatose patient to either wait for him to wake up on his own, or, if the coma lasts a long time, to turn him off from the life support system.

After a coma - a different personality

Sometimes things happen to people who have survived a coma that are difficult to rationally explain. So, having received a head injury. 35-year-old Englishwoman Heather Howland suddenly turned from an exemplary wife and mother into a sexually obsessed lady.

The accident occurred in May 2005. Heather suffered several brain hemorrhages and was in a coma for ten days. When Heather was released from hospital, her husband Andy took leave to care for his wife. At first he didn't notice anything strange. Three months later, Heather left the house for the first time. She went to the store. Andy, who was watching his wife from the window, was amazed to see that she approached the house opposite and spoke to the worker who was doing repairs in the absence of the owners. Then they both went up to the terrace and closed the door behind them. Through the glass it was visible that a man and a woman were kissing...

Since then, Andy's life has become a complete nightmare. Heather doesn't miss a single man. As soon as she is left alone, she heads to a bar for singles and meets sexual adventure seekers there. From time to time, acquaintances call Andy at work and ask him to urgently come and pick up his wife, who is behaving inappropriately, pestering strangers.

Doctors believe that the head injury led to irritation of the brain centers that are responsible for sexuality. They prescribed the woman a special course of drugs that suppress sexual desire.

Heather herself wants to change the situation. She voluntarily agreed not to leave the house for the period of treatment. The lady says that after recovery she had more than 50 sexual partners. “I woke up in the hospital with an incredible need to have sex all the time,” she says, “and it didn’t matter with whom. I don't recognize myself. After all, I’m not one of those who meet men on the street and invite them home to have sex.”

Relatively recently, there was information in the newspapers about 6-year-old California resident Zoe Bernstein. After the car accident, the girl spent about a month in a coma, and when she woke up, her relatives did not recognize her.

“She became a completely different person,” says Zoe’s mother. - The girl developed the so-called attention deficit disorder. A model child turned into a little hooligan. Although, maybe this is not so bad - after the accident she began to look more like her peers. On the other hand, this is a completely different girl, and the old Zoe who was before the car accident will most likely never return.”

Several years ago, a 13-year-old Croatian woman fell into a coma for 24 hours after a car accident. When the girl woke up, it turned out that she spoke German fluently. Before that, she studied German at school, but there was no particular success. But after the coma, the girl completely forgot her native Croatian!

And 26-year-old Briton Chris Birch fell into a coma after a strong blow during rugby training. “When I came to my senses, I very quickly realized that my orientation had changed,” says Chris. “I became gay and took it for granted.”

According to psychiatrist Miho Milas, such cases are known to science. Perhaps the secret lies in an unexpectedly awakened genetic memory. What if, after a coma, a completely different human personality can inhabit us?

Inner life

For a long time, doctors were convinced that in the comatose phase the patient’s brain is asleep and he is not aware of what is happening around him. Although there are many cases where, having come out of a coma, people said that they heard and understood everything that was happening, but could not react to it. Neurosurgeons in Britain managed to prove that a person in a coma does not turn into “vegetables” at all - he able to think and even react to words addressed to him.

2000 - Canadian Scott Routley was in a car accident, after which he fell into a coma. Despite the condition, the patient could open his eyes, move his fingers and distinguish between day and night. This patient became interested in Professor Adrian Owen from the University of Cambridge, who, together with his colleagues, developed a special technique that makes it possible to “read” the thoughts of people in a coma.

After scanning Scott's brain, the researchers asked him a series of questions that were expected to have either a positive or negative answer. At the same time, the tomograph recorded any manifestations of brain activity. The researchers concluded that Scott is aware of who he is and where he is, and reacts to external stimuli. In particular, he “answered” that he did not feel pain.

Later, a group of scientists examined a 23-year-old girl whose brain was damaged after the accident. The patient could neither move nor speak. When scientists asked the girl to imagine herself playing tennis, the scans revealed a surge of activity in the parts of the brain responsible for motor functions. The same thing was observed when scanning the brains of healthy volunteers who took part in the experiment. According to Dr. Owen, these results prove that the patient is at least capable of hearing speech addressed to her and mentally responding to it.

Thus, the answer to the question of whether euthanasia of people who have been in a coma for a long time is acceptable becomes even more controversial.

Miraculous return

Some experts advise to “communicate” more with a patient in a coma, talk to him, tell some stories - in their opinion, this allows the comatose person to maintain contact with real life and increases the chances of bringing him out of a vegetative state.

Cases where people came out of a coma contrary to doctors' predictions are not at all rare. A resident of the British town of Westonsuper-Mare (30 km west of Bristol) brought his wife out of a coma... with the help of swearing!

Yvonne Sullivan had an unsuccessful birth. The child died, and she herself received serious blood poisoning. Upon learning of the death of the baby, the woman fell into an unconscious state and did not emerge from it for two weeks.

Finally, doctors suggested taking her off life support. Hearing about this, Yvonne Dom's husband became so angry that he grabbed his unconscious wife by the hand and began shouting at her, reproaching her for not wanting to come to her senses. After 2 hours, Yvonne suddenly began to breathe on her own, and after another 5 days her sanity returned. According to the doctors, it was the “bashing” given by the husband that helped.

Alice Lawson, three years old, from Scunthorpe (England), today looks like a completely healthy and cheerful girl. Who would have believed that two years ago she was practically a “plant”, and doctors were going to kill a hopeless patient in order to transplant organs into a donor? But at the last moment a miracle happened and the girl came out of her coma.

At the age of one, Alice suffered meningitis and a stroke leading to kidney failure. She could not breathe on her own; life in her was supported only by equipment. In March, the parents decided to turn off the artificial respiration device and signed permission to remove their daughter’s organs for further transplantation. The day before, the Lawson couple spent the whole night at the girl’s crib. Alice's mother Jennifer brought her balloons, which the girl adored when she was healthy.

She talked with her daughter, told how all her relatives loved her. In the morning, Alice was given a morphine injection and disconnected from the equipment. Jennifer took her in her arms and kissed her. A transplant team was already waiting in the next room. Suddenly, the doctors noticed that the girl... was breathing on her own. She was alive!

Of course, the girl did not recover immediately and completely. For some time, Alice's reactions were at the level of an infant; she could not even hold her head up. In addition, one of her legs remains shorter than the other, but this can be corrected with surgery. Now the child goes to a correctional kindergarten. She draws and rides a bicycle that was customized especially for her. Relatives hope that over time Alisa will recover and catch up with her peers in development.

Coma is a condition that threatens a person’s life and is characterized by loss of consciousness, absent or weakened response to external stimuli, impaired frequency and depth of breathing, extinction of reflexes, changes in pulse, vascular tone, and impaired temperature regulation.

The development of coma is caused by deep inhibition in the cerebral cortex, which spreads to the subcortical and lower parts of the central nervous system due to head injuries, acute circulatory disorders in the brain, poisoning, inflammation, hepatitis, diabetes mellitus, uremia.

The goal of treating coma is to eliminate the causes that caused this condition and to take measures aimed at eliminating collapse, oxygen starvation, restoring breathing, and acid-base balance.

Types and causes of coma

Based on their origin, the following types of comatose states are distinguished:

Neurological coma. Its cause is inhibition of the central nervous system due to primary brain damage (apoplectic coma due to stroke, epileptic coma, traumatic coma, coma caused by brain tumors, coma due to meningitis, encephalitis);
To whom with endocrine diseases. This kind of coma is associated with metabolic disorders with insufficient levels of hormone synthesis (hypothyroid coma, diabetic, hypocorticoid), their excessive production or overdose of drugs based on hormonal drugs (thyrotoxic, hypoglycemic);
Toxic coma. This type of coma is associated with exogenous (coma due to poisoning), endogenous (coma due to liver or kidney failure) intoxication, toxic infections, pancreatitis, infectious diseases;
To whom, associated with gas exchange disorders:
To whom, due to the loss of electrolytes, energy substances, and water by the body.

Certain types of comatose states cannot be classified into any group (for example, coma caused by overheating of the body), and some can be classified simultaneously into several groups (electrolyte coma with liver failure).

Coma symptoms

The rate at which coma symptoms develop varies. Coma may occur:

Suddenly. The patient suddenly loses consciousness, and in the next minutes all the signs of coma appear: disturbances in the depth and rhythm of breathing, noisy breathing, a drop in blood pressure, disturbances in the rate and rhythm of heart contractions, and the functioning of the pelvic organs;

Fast. Symptoms increase over a period of several minutes to several hours;

Gradually (slowly). In this case, precoma first develops with an increase in the symptoms of the underlying disease, against the background of which there is a gradual increase in neurological and mental disorders. A change in consciousness can manifest itself as lethargy, drowsiness, lethargy or, conversely, psychomotor agitation, hallucinations, delirium, delirium, a twilight state, which are gradually replaced by stupor and coma.

There are 4 degrees of coma:

1st degree coma. Symptoms of a coma of this severity are characterized by: stupor, sleep, inhibition of reactions; the patient can perform simple movements; its muscle tone is increased, the reaction of the pupils to light is preserved; sometimes pendulum-like movements of the eyeballs are observed; the patient's skin reflexes are sharply weakened;
2nd degree coma. Characterized by deep sleep, stupor; a sharp weakening of reactions to pain; pathological types of breathing are observed; spontaneous rare movements are chaotic; involuntary bowel movements and urination may occur; the pupils are constricted, their reaction to light is weakened; Corneal and pharyngeal reflexes are preserved, skin reflexes are absent, muscular dystonia, pyramidal reflexes, and spastic contractions are observed;
3rd degree coma. Characterized by a lack of consciousness, corneal reflexes, and reaction to pain; suppression of pharyngeal reflexes; pupils do not react to light; muscle tone and tendon reflexes are absent; blood pressure is reduced; involuntary urination and defecation, arrhythmic breathing, and decreased body temperature are observed;
4th degree coma (exorbitant). It is characterized by complete areflexia, hypothermia, muscle atony, bilateral mydriasis, profound disruption of the medulla oblongata with a sharp decrease in blood pressure and cessation of spontaneous breathing.

The prognosis of coma depends on what caused it and the severity of the damage to the brain stem.

Rapid (within 20-30 minutes) restoration of brainstem and spinal reflexes, spontaneous breathing and consciousness of the patient determines a favorable prognosis for coma. With stage 3 coma, the prognosis for the patient is usually unfavorable; The prognosis for extreme coma is absolutely unfavorable, since it is a borderline state followed by brain death.

Treatment of coma

The initial measures in the treatment of coma are: ensuring airway patency and correcting cardiovascular activity and breathing. Next, the nature of the disease that caused the development of coma is clarified, and appropriate treatment is carried out. If the coma is caused by a drug overdose, then the patient is advised to administer naloxone. For purulent meningitis, antibacterial drugs are prescribed, for epilepsy - anticonvulsants. If the diagnosis is unclear, it is advisable to administer a dextrose solution.

In addition, symptomatic and pathogenetic treatment of coma is also used. For this use:

Hyperventilation and osmotic diuretics (for intracranial hypertension);
Anticoagulants and antiplatelet agents (for acute cerebral ischemia).

Treatment is provided for common diseases that are complicated by coma: kidney and liver diseases, diabetes mellitus. If necessary, plasmapheresis, detoxification therapy, and hemosorption are prescribed.

When emerging from a coma state, the functioning of the central nervous system is gradually restored, usually in the reverse order: first, the pharyngeal and corneal reflexes are restored, then the pupillary reflexes, and the severity of autonomic disorders decreases. Consciousness is restored, going through the following stages: confusion and stupor, delirium and hallucinations, motor restlessness.

When the patient’s condition has stabilized, the underlying disease that caused the development of coma is treated, and measures to prevent possible complications are applied.

Thus, coma is a dangerous condition indicating the presence of certain diseases, injuries, circulatory disorders in the brain, and lack of oxygen in the blood; about poisoning, the impact of psychogenic factors, which, when reaching a certain degree, can lead to death.

The prognosis for the development of this condition depends on the cause that caused it, the timeliness and adequacy of the therapeutic measures taken, and the characteristics of the patient’s body.

Irreversible processes in the brain, if I’m not mistaken, begin within 1-3 hours. That is, the longer a person remains in a coma, the more the brain dies. It is the brain that is responsible for consciousness, and the spinal cord for the unconscious. In other words, after a long time in a coma, the body loses the organ responsible for consciousness. As a result, only a shell remains - physically the arms, legs... will live, but it will no longer be a person.

A person can remain in a coma for a long time, it all depends on the severity of the illness or injury received, from several hours, days, months and up to ten years, until he comes to his senses or dies. One American was in a coma for 19 years after a car accident, and a Chinese woman was in a coma for 30 years.

Usually people fall into a coma due to a serious illness or injuries, especially to the brain. I know that you can be in a coma from several days to several years. People in a coma rarely survive or become disabled for life, but it all depends on doctors and proper care.

Until he dies, and with proper care this can last up to ten years or longer. But usually during this time a person catches a cold, bedsores develop, sepsis and everything...

It is very scary when a loved one is in a coma.

A person can lie in a coma from several days to several months, and even years.

The length of time you remain in a coma depends on several different factors.

A person can be in a coma for a completely different amount of time, from 3 days to several years.

It is simply impossible to determine how long a person can lie in a coma. A person can be in this state for several days, or several months and years. Even after being in a coma for several years, people can recover and return to normal life.

A person can remain in a coma for a very long time. There have been cases for ten years or more. In general, coma is scary. A person dies only when the brain dies. I had 2 friends in a coma, neither of them came out of this state.

Until they declare brain death. The more severe the brain damage, the heavier and deeper the coma and, accordingly, the less likely there is to come out of it.

If the pupil does not react to a beam of light during the day, then the chances are minimal.

And if the pressure drops below 80 and there is no muscle response, then the brain is dead..

Cases have been recorded of people being in a coma for years. The record length is 42 years. Eduarda OBara was in a coma for so many years, who fell into a coma at the age of 16, and all this time she was cared for first by her mother and then by her sister. She did not regain consciousness and died that way.

And there is a case when a person came to his senses after 19 years of being in a coma. I wrote about this, I won’t repeat it. This is also a record.

A person, if he cannot breathe on his own, will remain in a coma as long as he is connected to life support machines and until he is brain dead. If he breathes on his own, can swallow and is in a more or less stable condition, then he will be in a coma while someone is caring for him or until he dies from some disease that accompanies an immobile lifestyle, for example, from pneumonia . Well, or until he regains consciousness.

The length of time a person remains in a comatose state depends on many different factors. From the reasons that caused the coma, the intensity of treatment, care and others. Typically, this period can range from several weeks, months or even years.

How do people feel in a coma? Let's take a closer look at this issue.

Coma is a state of a person when he has a complete absence of consciousness, reactions to stimuli are sharply weakened or completely absent, reflexes fade away until they disappear completely, the breathing rate is disrupted, the pulse slows down or increases, etc.

When a person is in a coma, he is between life and death. And this is dangerous because in addition to loss of consciousness, during a coma a person’s vital functions of the body are disrupted. The classification of lumps will be presented below.

As a rule, this condition is a complication of a certain disease or appears as a result of some pathological event, such as injury, etc. However, the clinical symptoms of coma can be very diverse, which depends on the reasons for its occurrence.

To bring a person out of a coma, it is necessary to carry out resuscitation measures, which are aimed at maintaining the basic functions of the body in order to prevent brain death.

What people feel in a coma is of interest to many.

This human condition is based on two main mechanisms:

bilateral damage to the cerebral cortex;
primary or secondary damage to its trunk, where the reticular formation is located, which maintains the cerebral cortex in tone and activity.

This is a cerebral coma.

Damage to the brain stem occurs when a person has a stroke or traumatic brain injury. Secondary disorders, as a rule, occur when metabolic processes in the body change, for example, in case of poisoning, diseases of the endocrine system, etc.

In addition, there are cases of a combination of both mechanisms of coma, which is observed quite often. It is believed that this is the line between life and death.

As a result of this, the normal transmission of nerve impulses in the human brain becomes impossible, the activity of all structures that switch to an autonomous mode is lost. Thus, the brain temporarily ceases to function and control the processes occurring in the body.

Coma states are divided into several types depending on various factors and symptoms. The main classifications are those that differ in the causative factor and the depth of coma.

Due to the occurrence of coma, it happens:

with a primary neurological disorder (when it was caused by a certain process in the nervous system);
with a secondary neurological disorder (when the cause of coma is in no way connected with the nervous system).

Establishing the cause of this condition is necessary in order to correctly determine the patient’s treatment tactics.

From a medical point of view, this is a temporary immersion of the patient in an unconscious state. The activity of the cerebral cortex and subcortex is inhibited and all reflex functions are completely disabled.

Artificial coma is used only in the most extreme cases. That is, when there is no other way to protect the patient’s body from irreversible brain changes that threaten his life. This happens with swelling of brain tissue and compression effects on them, as well as with hemorrhage or bleeding accompanied by severe traumatic brain injuries or pathologies of cerebral vessels.

An artificial coma can be used to replace general anesthesia in cases of emergency surgery of a large volume or directly on the brain.

Coma of neurological (primary) origin

This type of coma occurs:

For traumatic brain injuries (traumatic).
In case of disturbances in the functioning of the cardiovascular system, as well as disorders of cerebral circulation (cerebrovascular coma). This happens with a stroke. A person may be in a coma for other reasons.
As a result of epileptic seizures.
Coma that occurs as a result of an inflammatory disease of the brain or its membrane (meningoencephalitic).
As a consequence of a tumor process in the brain (hypertension).

Varieties of this condition are:

endocrine coma (for example, with diabetes mellitus), thyrotoxic, hypothyroid (with pathologies of the thyroid gland), hypocorticoid (acute adrenal insufficiency), hypolituitary (acute deficiency of hormones produced by the pituitary gland);
toxic coma (during liver or kidney failure, poisoning, overdose of alcohol or drugs, as well as cholera;
hypotoxic form (in severe forms of heart failure, as well as anemia, pulmonary obstruction);
coma caused by exposure to any physical factors (hypothermia, overheating, electric shock, etc.);
coma caused by dehydration or electrolyte deficiency.

How dangerous is a coma? Is it possible to recover from a coma?

According to statistics, the most common cause of coma is stroke. In second place on this list is drug overdose, and in third place are the consequences of diabetes mellitus.

Classification of comas according to the depth of depression of consciousness: 1st degree (so-called “subcortical” coma, mild degree), 2nd degree (anterior brainstem, moderate severity), 2nd degree (posterior brainstem, deep), 4th degree (extraordinary, extremely severe condition).

The transition from one degree of coma to another is sometimes very abrupt, so it is sometimes quite difficult to determine the stage of coma in a patient.

This condition is called subcortical coma and is characterized by inhibition of the activity of the cerebral cortex, as well as the subcortical formations of this organ. This type of coma differs from others in the following characteristics:

feeling as if the patient is in a dream;
disorientation of a person in time and location;
lack of awareness of reality, slurred speech;
disappearance of reactions to painful stimuli;
increased muscle tone;
strengthening deep reflexes;
inhibition of surface reflexes;
preservation of the reaction of the pupils to light stimuli, strabismus, spontaneity of eye movements;
preserved breathing;
tachycardia (increased heart rate).

At this stage of cerebral coma, the activity of the subcortical zones begins to slow down, which characterizes this stage with the following conditions:

the occurrence of tonic convulsions or trembling of some parts of the patient’s body;
complete lack of speech, impossibility of verbal contact with the patient;
strong weakening of pain reactions;
sharp depression of both deep and superficial reflexes;
weak reaction of the pupils to light stimuli, their narrowing;
increased body temperature and excessive sweating;
sudden changes in blood pressure;
tachycardia;
violation of respiratory activity (breathing stops, different depths of inspiration).

Pathological processes occur in the medulla oblongata. In this case, the risk to the patient’s life is quite high, and the prognosis for recovery after a coma is significantly reduced. How do people in a coma feel? Stage 3 is characterized by the following conditions:

What other type of coma can happen? Coming out of a coma does not always happen.

In this state, a person has absolutely no signs of brain activity. And it shows up like this:

lack of reflexes;
full dilation of the pupils;
muscle atony;
a sharp decrease in body temperature and blood pressure (to zero);
absolute absence of spontaneous breathing.

Coma 4 degrees is an almost 100% probability of death.

Coma usually lasts from one to several weeks. However, there are a huge number of cases where this condition lasted much longer - up to several months and even years.

The patient's return to consciousness occurs slowly. At first, he may come to his senses for only a few minutes or hours, and over time this time increases. A person’s return to a normal state largely depends on the depth of the coma he experienced, as well as on a number of reasons why this condition arose.

The consequences of coma are sometimes very severe. During this condition, the brain is damaged, so the person may not recover some body functions. Very often, after a coma, people cannot walk, make movements with their hands, and there is a slowdown in speech activity or its complete absence.

After a first-degree coma, a person, as a rule, quickly comes to his senses, and his body in most cases does not lose its abilities. After a third-degree coma, the brain is almost completely destroyed. Accordingly, after this, a person no longer has the opportunity to live a full life.

The consequences of a coma can also be memory impairment, changes in human behavior (aggressiveness or lethargy), decreased attention and reactions. After suffering a comatose state, people recover their abilities for a very long time, even in the everyday sphere - feeding themselves, bathing, changing clothes, etc.

The experiences and sensations of a person who is in a comatose state have been studied for many years in various countries around the world. However, there are still no reliable facts about this.

Nevertheless, scientists still made some conclusions, for example, it has been scientifically proven that even those people who are in a state of deep coma experience certain states, and the brain has some activity. Thus, it turned out that a patient in a coma has the internal ability to respond to external stimuli. This fact is due to the fact that special research equipment recorded special brain waves emitted at moments when relatives and friends speak to a person. What else do people feel in a coma?

The patient internally reacts to tactile sensations, which can also be confirmed by rapid heartbeat, changes in breathing intensity, or changes in blood pressure. This can confirm that a person experiencing a comatose state reacts in a certain way to events occurring in the outside world and responds to them. What people feel in a coma can be told by those who have successfully come out of it.

Many people who have experienced this condition share their feelings and experiences. Some of them claim that they were in a kind of altered state of consciousness, when they seemed to travel between worlds, could see their deceased relatives and even talk to them. Other patients claim that they were conscious, heard the speech of doctors, relatives who were next to them, but could neither move nor in any way confirm their ability to understand everything. The third group of people in a coma may have had a variety of dreams, or they were in a state of unconsciousness, when after waking up from the coma they could not remember absolutely anything.

Prekoma. While in this state, the person remains conscious, but there is slight confusion in actions and lack of coordination. The body functions according to the concomitant disease.
Coma 1st degree. The body's reaction is very inhibited even to strong stimuli. It is difficult to find contact with the patient, but he can make simple movements, for example, turning over in bed. Reflexes are preserved, but are very weakly expressed.
Coma 2nd degree. The patient is in a deep stage of sleep. Movements are possible, but they are performed spontaneously and in a chaotic manner. The patient does not feel touch, the pupils do not react to light in any way, and respiratory function is impaired.
Classifying coma according to the degree of its depth, we can distinguish the following types of this condition:

In this article we will take a closer look at the condition of a person in a penultimate degree coma.

This is a very dangerous condition for human life, in which the body cannot practically function independently. Therefore, it is impossible to predict how long the unconscious state will last. It all depends on the body itself, on the degree of brain damage, and on the age of the person. Coming out of a coma is quite difficult; as a rule, only about 4% of people are able to overcome this barrier. Moreover, even if the person has regained consciousness, most likely he will remain disabled.

If you are in a third-degree coma and return to consciousness, the recovery process will be very long, especially after such serious complications. As a rule, people learn to speak, sit, read, and walk again. The rehabilitation period can take quite a long time: from several months to several years.

According to studies, if in the first 24 hours after the onset of a coma a person does not feel external irritants and pain, and the pupils do not react to light in any way, then such a patient will die. However, if at least one reaction is present, then the prognosis is more favorable for recovery. It is worth noting that the health of all organs and the age of the patient who has developed a 3rd degree coma play a huge role.

About thirty thousand people a year die as a result of road accidents and three hundred thousand become their victims. Many of them become disabled as a result. One of the most common consequences of a road accident is traumatic brain injury, which often causes a person to fall into a coma.

If, after an accident, a person’s life requires hardware support, and the patient himself has no reflexes and does not respond to pain and other stimuli, a 3rd degree coma is diagnosed. The chances of survival after an accident that leads to this condition are negligible. The prognosis for such patients is disappointing, but there is still a chance of returning to life. It all depends on the degree of brain injury as a result of the accident.

If a stage 3 coma is diagnosed, the chances of survival depend on the following factors:
- Degree of brain injury.
- Long-term consequences of TBI.
- Fracture of the base of the skull.
- Fracture of the cranial vault.
- Fracture of the temporal bones.
- Concussion.
- Trauma to blood vessels.
- Brain swelling.
A stroke is a disruption of the blood supply to the brain. It happens for two reasons. The first is blockage of blood vessels in the brain, the second is bleeding in the brain.

One of the consequences of cerebrovascular accident is coma (apoplectiform coma). In case of hemorrhage, a 3rd degree coma may occur. The chances of surviving a stroke are directly related to age and the extent of the damage. Signs of this condition:
- Lack of consciousness.
- Change in complexion (becomes purple).
- Loud breathing.
- Vomit.
- Trouble swallowing.
- Slowing heart rate.
- Increased blood pressure.
The duration of the coma depends on a number of factors:
- Coma stage. In the first or second stage, the chances of recovery are very high. With the third or fourth, the outcome is usually unfavorable.
- Condition of the body.
- Patient's age.
- Equipping with necessary equipment.
- Patient care.
This condition has its own distinctive features:
- Lack of response to pain.
- The pupils do not respond to light stimuli.
- Lack of swallowing reflex.
- Lack of muscle tone.
- Reduced body temperature.
- Inability to breathe independently.
- Bowel movements occur uncontrollably.
- Presence of seizures.
As a rule, the prognosis for recovery from a third-degree coma is unfavorable due to the absence of vital signs.

A child may fall into a coma in the event of a deep disorder of the central nervous system, which is accompanied by loss of consciousness. The reasons for the development of coma in a child are the following pathological conditions: renal and liver failure, meningoencephalitis, brain tumor and trauma, diabetes mellitus, water and electrolyte imbalance, cerebral hemorrhage, hypoxia during childbirth and hypovolemia.

Newborns fall into a comatose state much more easily. It is very scary when a third degree coma is diagnosed. A child has a higher chance of survival than older people. This is explained by the characteristics of the child’s body.

In the case when a 3rd degree coma occurs, the newborn has a chance of survival, but, unfortunately, it is very small. If the baby manages to get out of a serious condition, severe complications or disability are possible. At the same time, we must not forget about the percentage of children, albeit small, who managed to cope with this without any consequences.

The longer the unconscious state lasts, the more difficult it will be to get out of it and recover. A 3rd degree coma can occur differently for everyone. The consequences, as a rule, depend on the degree of brain damage, the length of time spent in an unconscious state, the reasons that led to the coma, the health of the organs and age. The younger the body, the higher the chances of a favorable outcome. However, doctors rarely make a prognosis for recovery, since such patients are very sick.

Despite the fact that newborns recover from a coma more easily, the consequences can be very sad. Doctors immediately warn relatives how dangerous a 3rd degree coma is. Of course, there are chances of survival, but at the same time a person may remain a “plant” and never learn to swallow, blink, sit and walk.

For an adult, a prolonged stay in a coma is fraught with the development of amnesia, the inability to move and speak, eat and defecate independently. Rehabilitation after a deep coma can take from a week to several years. In this case, recovery may never occur, and the person will remain in a vegetative state for the rest of his life, when he can only sleep and breathe independently, without reacting in any way to what is happening.

Statistics show that the chance of a full recovery is extremely small, but such events do happen. Most often, death is possible, or in case of recovery from a coma - a severe form of disability.

The main complication after a coma is a violation of the regulatory functions of the central nervous system. Subsequently, vomiting often occurs, which can enter the respiratory tract, and stagnation of urine, which can lead to bladder rupture. Complications also affect the brain. Coma often leads to breathing problems, pulmonary edema and cardiac arrest. Often these complications lead to biological death.

Modern medicine makes it possible to artificially maintain the vital functions of the body for quite a long time, but the question often arises about the feasibility of these measures. This dilemma arises for relatives when they are informed that the brain cells have died, that is, in fact, the person himself. Often a decision is made to remove artificial life support.

In 2009, a 17-year-old Daniela Kovacevic from Serbia, blood poisoning occurred during childbirth. She fell into a comatose state, and doctors call her recovery from the coma after 7 years anything other than a miracle. After active therapy, the girl can move around (with the help of strangers for now) and hold a pen in her hands. And those who are on duty near the bedside of patients in a coma have hope that the same miracle can happen to their loved ones.

More than 3 years ago, she found herself in a comatose state. Maria Konchalovskaya, daughter of director Andron Konchalovsky. In October 2013, in France, the Konchalovsky family was involved in a serious accident. The director and his wife Yulia Vysotskaya escaped with minor bruises thanks to the deployed airbags. And the girl, who was not wearing a seat belt, received a severe head injury. Doctors saved the child's life, but warned that recovery would be long. Alas, their prediction came true. The girl's rehabilitation continues.

Rehabilitation continues for 21 years Colonel General Anatoly Romanov, commander of the united group of federal troops in Chechnya. On October 6, 1995, his car was blown up in a tunnel in Grozny. Romanov was literally assembled piece by piece. Thanks to the efforts of doctors, after 18 days the general opened his eyes and began to respond to light, movement and touch. But the patient still does not realize what is happening around him. What methods did the doctors use to “break through” into his consciousness? For 14 years, the general was treated at the Burdenko hospital. Then he was transferred to a hospital for internal troops near Moscow. But for now, this strong and courageous man, as doctors say, is in a state of minimal consciousness.

Sharon Stone suffered an intracerebral hemorrhage, which left her in a coma for 9 days. Stevie Wonder, American blind soul singer, was in a serious car accident and was in a coma for 4 days; after leaving, he partially lost his sense of smell. In 2013, he received a severe head injury seven-time Formula 1 champion Michael Schumacher. He remained unconscious for more than six months. Then there was progress in his condition, but rehabilitation continues to this day.

Until now, only one case is known in which a patient, after a long coma, managed to return to a full life. June 12, 1984 Terry Wallace from Arkansas, having drunk a fair amount, went for a ride with a friend. The car fell off a cliff. The friend died, Wallace fell into a coma. A month later he entered a vegetative state, in which he remained for almost 20 years. In 2003, he unexpectedly uttered two words: “Pepsi-Cola” and “mom.” After conducting an MRI study, scientists discovered that the incredible had happened: the brain repaired itself, growing new structures to replace the damaged ones. Over 20 years of immobility, all of Wallace's muscles atrophied and he lost the simplest self-care skills. He also did not remember anything about the accident or the events of the past years. In fact, he had to start life from scratch. However, the example of this man still gives hope to those who continue to fight for the return of their loved ones to normal life.

Mikhail Piradov, Academician of the Russian Academy of Sciences, Director of the Scientific Center for Neurology:

- From the point of view of pathophysiology, any coma ends no later than 4 weeks after its onset (if the patient does not die). Possible options for exiting a coma: transition to consciousness, a vegetative state (the patient opens his eyes, breathes independently, the sleep-wake cycle is restored, there is no consciousness), a state of minimal consciousness. A vegetative state is considered permanent if it lasts (according to various criteria) from 3-6 months to a year. In my long practice, I have not seen a single patient who emerged from a vegetative state without loss. The prognosis for each individual patient depends on many factors, the main of which are the nature and nature of the injuries received. The most favorable prognosis is usually for patients with metabolic (eg, diabetic) coma. If resuscitation care was provided competently and in a timely manner, such patients recover from coma quickly enough and often without any losses. However, there have always been, are and will be patients with severe brain damage, who are very difficult to help even with the highest level of resuscitation and rehabilitation. The worst prognosis is for comas caused by vascular origin (after a stroke).

Every day new patients are admitted to hospitals in different cities. Sometimes a patient has to make a choice in favor of one treatment or another, or refuse it altogether, but what should someone who is in a coma do?

People in deep sleep cannot make decisions and therefore this heavy responsibility falls on the shoulders of their immediate family. To understand what to do in such a situation, you need to know what a coma is, how you can bring a person out of it and what its consequences are. Let's talk about this.

Coma refers to a severe comatose state in which a man is in deep sleep. Depending on the degree of coma the patient has, various functions of the body may be slowed down, brain activity may be disabled, metabolism and the functioning of the nervous system may be completely stopped or significantly slowed down.

The cause may be: stroke, brain injury, meningitis, epilepsy, encephalitis, hypothermia or overheating of the body.

Coma is conventionally divided into 5 degrees of severity, namely:
- 1st degree - precoma. Those affected by this gradually begin to experience general lethargy, a drop in reaction, a feeling of drowsiness, lack of sleep, and confusion in consciousness. It’s rare, but it still happens that everything happens the other way around, in excessive excitement. Reflexes at this stage are preserved, while the work of all internal organs is already inhibited. Sometimes precoma is called nothing more than a state before a coma, and is not referred to as a coma at all.
- 2nd degree - initial level of severity. Reactions to external stimuli begin to slow down. The person still has the ability to swallow liquid food and water, he can move his limbs, but only slightly.
- 3rd degree - moderate level of severity. The patient is already entering a state of deep sleep, contact with him becomes impossible. Only sometimes movements of the limbs can be observed, but rarely they are conscious. The skin already has low sensitivity, a person walks under himself.
- Grade 4 - high level of severity. There is a lack of feeling of pain, consciousness, tendon reflexes, and no reaction to light. Not only body temperature is reduced, but also breathing pressure.
- 5degree - severe coma. The disturbance of consciousness becomes profound, reflexes are absent. Breathing stops and the patient is transferred to an artificial respiration apparatus.
Only specialists can recognize who it is. For these purposes they conduct the following research:
- The level of alcohol in the blood is determined to exclude alcohol intoxication, which may temporarily turn off consciousness.
- The presence of drugs in the blood is determined to exclude drug-induced fainting.
- An electrocardiogram is performed.
These are only general studies; special ones can be prescribed by doctors if necessary.

Doctors still cannot answer the question of how long people can remain in a coma. The thing is that history knows of cases when, after 12 years, people managed to get out of a coma. This is purely individual and one person can come out of this state in just three days, while others will spend years of their life in it.

It is worth saying that doctors often, after several years, advise relatives to make a decision to disconnect a person from the devices that support his life. The prognosis is becoming unfavorable, and maintaining life is not cheap, so many agree to this step. But do not forget that the person is still alive, he just cannot live without special help. The longest recorded time a person spent in a coma was 37 years.

The reactions have already been mentioned earlier; depending on the severity, a person may or may not feel touch. All people who have experienced coma claim that they heard everything that was happening around them, but could not understand whether it was a dream or reality.

Doctors also claim that when relatives often communicate with patients in a coma, they begin to experience active activity in the part of the brain responsible for facial recognition. Also, active impulses appear in the centers responsible for emotions.

Someone claims to have met with deceased relatives; all this happens in patients in a state of sleep, in which, as we know, anything can happen.

Unfortunately, today there is no answer to the question that interests everyone, “how to bring a loved one out of a coma.” All that doctors advise is to talk to the person, hold his hand, let him listen to music, read books. Sometimes a sound or phrase helps a person, grasping it like a thread, come out of a comatose state.

Coming out of a coma occurs gradually. At first, a person may wake up for a couple of minutes, look around and fall back asleep. An hour or two will pass and he will wake up again, and this happens several times.

After waking up from a coma, a person will need a lot of time to adapt. Everything around him seems strange; if he has spent more than a year in this state, he needs time to realize that so much time has passed. You should not expect that a person will immediately get back on his feet and begin to live the same way as before. Speech will not be restored immediately.

At this moment, a person will need the help of loved ones more than ever, everything around will be foreign to him and it will be like a child starting to learn to walk and talk again.

Due to the fact that a comatose state is characterized by brain damage, you need to understand that it will take time to restore some functions. For rehabilitation, special developmental simulators will be required.

Immediate consequences include memory problems, even amnesia. Lethargy, absent-mindedness, and aggressiveness may appear. Don't be afraid, all this can be restored, you just need time and patience. A person may have lost everyday skills, so he will need to be taught everything again. It is easy to understand what consequences await those who have spent more than five years in a coma; during this time, a lot has changed around them and then the person needs to be introduced to everything around him.

A coma is certainly scary, but if your loved ones find themselves in it, you don’t need to give up, because people come out of it, and then begin to live their old lives again, even if not immediately.

Coma is a phenomenon that is not fully understood by doctors and scientists. A person can remain unconscious for several hours or years, seemingly not reacting in any way to external stimuli. However, recent studies show that patients do not completely lose contact with the world.

By definition, coma is a state characterized by complete loss of consciousness. A person in a coma has no active movements, breathing and cardiac activity are impaired. Often, doctors and relatives of the patient are faced with the question of whether they should expect a miracle, or whether the patient should be taken off life support and allowed to die. However, a person in a coma may be much more alive than they seem.

As a rule, relatives and relatives come to visit a person lying in a coma. They read to him, tell him the latest news and events from their lives. Outwardly, the patient does not react in any way to their presence, but if you connect special equipment, a different picture emerges. For example, German scientists discovered an interesting phenomenon in a young man who fell into a coma after a serious accident and resulting traumatic brain injuries. Every time the girl he loved came to visit the unlucky motorcyclist, the patient’s heart began to beat faster, which was recorded by the equipment. Subsequently, when the young man began to recover, it was the girl’s presence that had a beneficial effect on him and contributed to his recovery.

By paying attention to the brain of those lying in a coma, you can also find that it is not at rest. Based on the ripple changes, patients respond to the presence of loved ones as well as what they say to them, according to research conducted at the University of Tübingen in Germany. Every fourth person has this ability. Hugging or touching also affects heart function and brain activity. The more pronounced such reactions are, the greater the patient’s chances of emerging from a coma.

Not only people lying in a coma, but also patients under anesthesia are capable of reacting to the words of others and external stimuli, as well as experiencing emotions depending on their content. A curious incident occurred in a German clinic during an operation on a particularly overweight patient. While he was unconscious on the operating table, the doctors allowed themselves to make a couple of jokes about his excess weight. Waking up from anesthesia, the patient was outraged and upset by the ridicule he heard. For this reason, relatives and medical personnel are not recommended to make negative predictions while at the bedside of an unconscious or comatose person.

How do people feel in a coma?

In a stage 4 coma, the chances of survival are negligible. If within 20-30 minutes during resuscitation measures it was possible to achieve restoration of spontaneous breathing, spinal or brainstem reflexes, electrical impulses of the brain, then stabilization of such a patient is possible.

The severe unstable condition of a patient with a 3rd degree coma can progress until a 4th degree coma develops. This is a transcendental state, which is characterized by deep depression of all body functions. Life support is possible with the help of artificial respiration devices, parenteral nutrition and medications

Causes
Clinical manifestations
Management of a patient in a coma
Brain death
Pseudocomatose states
Results

Causes

A terminal condition occurs as a complication of a serious illness that cannot be treated:

Diabetes mellitus, hypothyroidism.
Brain injuries.
Tumors and cerebrovascular disorders.
Severe intoxication, poisoning with ethanol, drugs.

Clinical manifestations

The patient's reflexes completely disappear, muscle atonia develops, and he does not respond to pain and exogenous stimuli.
Blood pressure is maximally reduced, pulse is frequent or pathologically slow.
Breathing is difficult, unproductive, and apnea may develop.
The pupils are dilated and do not constrict to light.
Body temperature drops.
The EEG shows the absence of bioelectrical activity of the brain.

Management of a patient in a coma

If the patient’s condition sharply worsens and there are suggestions of brain death, emergency measures are necessary:

Connecting an artificial respiration device.
Maintaining blood pressure with medications.
Providing venous access by installing a catheter in the central vein.
Feeding through a gastric tube.
Prevention of bedsores and pneumonia.

Forecast! In a stage 4 coma, the chances of survival are negligible. If within 20-30 minutes during resuscitation measures it was possible to achieve restoration of spontaneous breathing, spinal or brainstem reflexes, electrical impulses of the brain, then stabilization of such a patient is possible. Otherwise, the outcome will be brain death.

Brain death

Based on data indicating the cessation of functioning of the brain and its stem, brain death is confirmed by a council of doctors. This concept is legally enshrined and defines the death of a person, despite the presence of cardiac activity and breathing supported artificially.

Subscribe to our Yandex Zen channel!

Life support systems have a high cost, so at a certain stage the question is raised about disconnecting the patient from life support devices. This creates the possibility of obtaining donor organs for transplantation.

The following criteria for brain death have been defined:

Damage to the brain structure. There must be a history of trauma, after which it is impossible to definitely restore its structure. Diagnosis is carried out using CT.
A full examination confirms that the depressed state is not caused by intoxication.
Body temperature 32°C or more. A hypothermic state can lead to a decrease in electrical activity on the EEG, but when the temperature rises, the indicators are restored.
The observation period for injuries ranges from 6 to 24 hours; after drug intoxication and in children, the observation time is increased.
Does not react with movement to severe pain, there are no reflex reactions to pain in the form of rapid breathing or heartbeat.
Apnea is confirmed by a special test. Ventilation of the lungs is carried out with pure humidified oxygen or mixed with carbon dioxide for 10 minutes. After this, its feed is reduced. Spontaneous breathing should return within 10 minutes. If this does not happen, brain death is diagnosed.
Absence of corneal reflexes: no eye movement during cold testing, fixed pupils, corneal, pharyngeal, gag reflexes, blinking, swallowing disappear.
EEG in the form of an isoelectric line.
According to angiography, there is no blood flow. During ophthalmoscopy, glued red blood cells are found in the retina - a sign of stopping blood flow.

Pseudocomatose states

Coma state 4 must be differentiated from other conditions that are accompanied by similar symptoms:

1. Locked-in syndrome. Damage to the motor tract leads to paralysis of the muscles of the limbs, neck and face, and is a consequence of blockage of the main artery or tumor of the bridge, a demyelinating process. Patients cannot move or pronounce words, but understand speech, blink, and move their eyes.

2. Akinetic mutism. Stroke, injury to the thalamus, midbrain, caudate nucleus, motor and sensory pathways are damaged, paresis or paralysis of the muscles of the limbs develops, and speech is lost. A person can open his eyes, sometimes perform some movements or pronounce words in response to a painful stimulus. But wakefulness takes place without the participation of consciousness. After recovery, the patient remains amnesic.

3. Abulia. The lesions are located in the temporal lobes, midbrain and caudate nucleus. The ability to move and speak is impaired. Sometimes patients can emerge from this state and respond adequately to stimuli, and then return to their original state.

4. Severe depression. Accompanied by a state of stupor, complete immobilization and loss of contact are possible. The condition develops gradually. Diagnostic CT or MRI does not reveal signs of brain damage.

5. Hysteria. People with pronounced affective behavior after a traumatic situation experience complete immobilization and withdrawal. There are no signs of organic damage to brain structures.

Results

The outcome of coma 4 can be a vegetative state. It is characterized by alternating sleep and wakefulness, but it is impossible to establish contact, there is no awareness of the individual. Breathing is spontaneous, blood pressure and cardiac activity are stable. Movements are possible in response to stimuli.

This condition lasts for at least a month. It will never be possible to get out of it. Higher brain functions are not restored. The patient's death occurs from additional complications. published .

All reviews

For any person, even those who have nothing to do with medicine and are not faced with the nuances of such a diagnosis as coma, this word sounds terrifying

The state in which a person is comatose, is dangerous for the person himself and very frightens loved ones, because The process of coming out of a coma is always unpredictable. Even doctors can never be sure when a person will come out of a coma or whether he will be able to come out at all.

Medically, staying in a coma characterized by an unconscious state of the patient in which there are no reactions to external stimuli. Some compare this state to sleep, but this is not at all true. The brain of a person in a coma functions at the most borderline level of alertness.

Duration of stay in coma may range from a few days to significant and prolonged periods of unconsciousness. Most often, the coma lasts several weeks. However, history knows of cases where people remained in a coma for several years.

Cause of coma Almost always there is a previous coma, trauma. Head injuries, brain damage, stroke, severe drug poisoning, exposure to drugs and even alcohol often cause a person to fall into a coma. People react differently to various external negative influences. That is why the duration of stay in a coma may differ for different people, even if the reasons for its occurrence are the same.

In medicine there is a distinction several types of coma, depending on the duration of stay in it and the degree of impact on basic life functions.

Coma can be deep - this is the most dangerous type, in which a person does not react in any way to any external stimuli (voice, tactile touches). In such a patient, the activity of any life support system may also cease or be superficial. So, often the patient cannot breathe on his own, then he is connected to an artificial respiration apparatus. Nutrients necessary for normal life are introduced into the body intravenously.

Another type of coma is characterized by the possibility of a person’s partial reaction to a voice or external stimuli. Sometimes the patient may even make some incoherent sounds, make minor movements, and open his eyes. Such a coma, although less deep than the first type, nevertheless poses a significant threat to human life. The longer a person remains in this state, the more negative the consequences may be in the future.

The third type of coma is superficial coma, which, based on its name, is characterized by a shorter duration. This coma can last only a couple of hours. In addition, in a state of superficial coma, a person has a reaction to the external environment, of course unconscious. The patient can open his eyes and even answer some questions.

For a person in a coma, special care is important; such a patient must constantly be under the supervision of a doctor, so that the slightest changes in the patient’s condition can be monitored and react in a timely manner.

Coming out of a coma always very complex and long-lasting, even in cases where there is a superficial coma. The person gradually and slowly comes to his senses. Partially and temporarily, the ability to speak, see, and adequately respond to external reactions initially returns to him. Then the patient can again fall into a state of deep sleep. Only after months and sometimes years of rehabilitation does a person return to full functioning.

Comments

On the portal

MY SON HAS BEEN IN A COMA AFTER OPERATION SINCE MAY 2. HE WAS DIAGNOSED OF SEVERE BRAIN CONUSION WITH COMPRESSION BY ACUTE EPIDURAL HEMATOMA OF THE RIGHT HEMISPHERE. MULTIPLE CONTUSIONAL FOCI OF 2-3 TYPES IN BOTH HEMISPHERES OF THE BRAIN GA. PNEUMOCEPHALY. DISLOCATION SYNDROME.COMA ON MAY 1.4 DECOMPRESSIVE CRANIECTOMY..REMOVATION OF EPIDURAL HEMATOMA OF THE RIGHT PAROTEMPORAL REGION.TRACHEOCOMA.MAY 3 RECOGNIZED A COMA BUT THE CONDITION WORSE AGAIN.PNEUMONIA.Bedsores ON THE STUPLE YAH.WHAT TO EXPECT.

Required fields are marked with an asterisk (*).

From a medical point of view, an induced coma is an unconscious state into which a person is placed for a certain period of time. In this case, there is a deep inhibition of the activity of the subcortex and brain, a complete shutdown of all reflexes.

This measure is justified when doctors see no other way to stop irreversible changes that threaten life. These include compression effects, hemorrhages and bleeding.

If the patient is undergoing major surgery or complex surgery, coma can replace general anesthesia.

If the patient is put into a medically induced coma, the metabolism of brain tissue slows down and the intensity of blood flow decreases. Induction into a coma should be carried out only in intensive care units and intensive care units, under the constant supervision of doctors. Drugs that depress the central system are used - barbiturates and their derivatives. Doses are selected individually and correspond to the stage of surgical anesthesia.

Symptoms of a medically induced coma are as follows:

immobilization and complete relaxation of muscles; unconsciousness, absence of all reflexes; body temperature drops; blood pressure decreases; Heart rate decreases: atrioventricular conduction slows down; the work of the gastrointestinal tract is blocked.

This condition causes oxygen deficiency, so the patient is immediately connected to a ventilator - a breathing mixture of oxygen and dehumidified air is supplied. Thanks to this, carbon dioxide is released from the lungs, and the blood is saturated with oxygen.

The duration of a medically induced or induced coma may vary. When the patient is in this state, all vital signs are recorded on special equipment. They are constantly monitored by specialists and an anesthesiologist.

Today, several methods are used for these purposes. First of all, encephalography is used to monitor the activity of the cerebral cortex. The patient is connected to this device constantly.

Cerebral blood flow is measured using the following methods:

local laser flowmetry, when a sensor is inserted into the brain tissue; radioisotope measurement of blood circulation.

A ventricular catheter is inserted to measure intracranial pressure. It is periodically necessary to take a blood test from the patient's jugular vein to avoid cerebral edema.

The following imaging methods are used for diagnosis:

computed tomography; magnetic resonance imaging: positron emission computed tomography.

It is very difficult to say when a coma can be considered hopeless. Experts are still discussing this issue. In many Western countries, it is believed that a patient has no chance of recovery if the vegetative state continues for more than six months. Other factors are also taken into account: clinical assessment of the general condition, causes of the syndrome.

It is important to understand that an induced coma is not a disease. This is a cycle of targeted actions that ensure that patients are placed in a coma due to medical conditions, such as stroke or pneumonia.

The duration of the coma depends on the nature and severity of the disease. This period can range from several days to several months. Conclusion from this condition can be carried out only after the cause and signs of the disease have been eliminated.

Before this, a comprehensive examination of the patient is required to determine his condition.

Neurosurgeons believe that the consequences that may occur after a medically induced coma depend on the reason that became the basis for putting a person into this state. Ventilation has many side effects. Complications may occur in the respiratory system, which will provoke the development of tracheobronchitis, pneumonia, stenosis, and there is also the possibility of the formation of fistulas in the walls of the esophagus.

As a result of a medically induced coma, consequences such as impaired blood flow, pathological changes in the functionality of the gastrointestinal tract, which has not worked for a long time, and renal failure may occur. It is not uncommon for a patient to develop neurological disorders after recovering from this state.

A stroke causes brain damage, and irreversible consequences can occur in a matter of hours. To reduce the risk and remove the blood clot, the person is put into an induced coma.

But this method of treating some diseases is quite dangerous.

The saddest prognosis may be with subarachnoid hemorrhage. It occurs as a result of a head injury or rupture of an arterial aneurysm during a stroke. The shorter the period of time in a coma, the greater the patient’s chances of recovery.

Of course, this treatment method is risky, but a successful outcome is not uncommon. After such anesthesia, a person faces a long period of rehabilitation. It takes time for all body functions to be restored. Some people are able to return to normal life within a year, others take a little longer. During the rehabilitation period, it is imperative to undergo a comprehensive examination and follow all doctor’s prescriptions.

The most common complications after a coma can be the following:

brain damage of various types; breathing problems; pulmonary edema; blood pressure surges; heart failure.

Such complications can cause first clinical and then biological death. Vomiting is no less dangerous - masses can enter the respiratory tract. Urinary retention can lead to bladder rupture and peritonitis.

People can remain in this state for a very long time. Modern equipment makes it possible to maintain vital functions. But is this advisable?

To answer this question, it is necessary to take into account not only the state of the brain, but also many factors: is there an opportunity to care for the patient, how high is the quality of medical supervision.

The moral side of this issue is no less important. Sometimes a real war breaks out between medical staff and relatives.

To understand whether it makes sense to save the patient’s life, you need to take into account his age, the reasons that caused the coma and many other factors.

Stroke is a dangerous disease - every year about 5.7 million people around the world die from acute cerebrovascular accident. Causing numerous disturbances in the functioning of the brain, the disease often leaves many negative consequences. A severe complication of a stroke is coma - a condition in which the functioning of the central nervous system is inhibited, the regulation of the most important functions of the body is disrupted, consciousness is completely absent, and the patient does not respond to any, even very intense, stimuli.

One of the complications of stroke is coma.

Mechanism of development of coma during stroke

The proper functioning of the central nervous system depends on the completeness and continuity of the delivery of oxygen and glucose in the blood to the brain tissues. During a stroke, as a result of blockage or rupture of a vessel, cerebral blood flow is disrupted, and the delivery of energy substances to the most important centers for the regulation of vital processes is hampered or completely stopped. In the absence of oxygen and glucose, the brain can work for 2 minutes, while consciousness is lost within 10-15 seconds. Hypoxia has a detrimental effect on neural connections in the brain, causing their death; metabolites and sodium ions accumulate in tissues, which leads to the accumulation of intracellular fluid, brain edema, increased intracranial pressure and disruption of water-electrolyte balance. All these pathological changes lead to the development of coma, which in stroke is cerebrovascular in nature.

Characteristics of coma after stroke

The main question that worries the relatives of a patient who is in a coma after a stroke is how many days or weeks this condition can last, and what are the chances of a full recovery after leaving the coma.

Unfortunately, the forecasts of experts are disappointing - the chance of a full life for a person who has fallen into a deep coma is very small. How long the patient was unconscious is also of great importance. For example, in a coma that lasts more than 4 months, the chances of recovery are only 15%.

In isolated cases, patients woke up several years after falling into a coma

The duration of a coma largely depends on its depth and the degree of damage to brain structures:

The first degree is characterized by pronounced retardation of the patient, confusion, inhibited reaction to external stimuli, even quite strong ones. The patient is able to follow simple commands, he can change his position in bed, the swallowing reflex is preserved. In a patient in a first-degree coma, muscle tone increases. Often such patients have difficulty making contact. Recovery from this state occurs quite quickly, within the first 3 hours after a stroke. After awakening, a person may experience severe drowsiness and lethargy, but a repeat incident is rare. As a rule, this condition has a favorable prognosis; with proper rehabilitation, recovery can occur very quickly. The second degree of coma after a stroke is the onset of deep sleep. The patient's consciousness is depressed, it is impossible to establish contact with the patient. The reaction to painful stimuli is sharply weakened, all muscle movements are spontaneous and uncontrolled. Breathing function also suffers - it can be shallow and frequent. Second-degree coma can last from several tens of hours to 2-3 days, how long depends on the characteristics of the disease. There are still chances for a full recovery. The third degree is characterized by a complete lack of consciousness and reaction to stimuli. The swallowing reflex is depressed and the pupils do not respond to light. Muscle tone is significantly reduced, and a seizure may develop. Third-degree coma is accompanied by a drop in blood pressure to critical values, body temperature drops sharply, and vital functions are inhibited. This condition can last from several days to several months, recovery occurs in rare cases, and there may be no chance of recovery. The fourth, or extreme stage of coma is combined with a complete absence of reflexes, muscle atony, hypothermia, respiratory arrest and cardiac arrhythmia. Most of the brain is damaged, so recovery is not possible.

After falling into a coma, a person may remain unconscious from several hours to several days, most often 2-3 days. Sometimes the patient may fall into a vegetative state, in which the function of the cerebral cortex is disrupted and the person loses the ability to carry out higher nervous activity, while basic vital functions are preserved. The longer the unconscious state persists, the less chance of full recovery. It is very difficult to predict how long something like this will last.

How to recognize the onset of coma?

The duration of unconsciousness can be reduced if the symptoms of an impending coma are recognized in time. Signs of a stroke followed by the development of coma are:

Incoherent speech, confusion, delirium. Distortion of facial expressions. A few minutes after the first signs of a stroke, the patient stops responding to stimuli, vomiting, spontaneous urination and defecation are possible. There is numbness of the limbs on one or both sides, which gradually develops into paralysis. The pulse slows down, breathing becomes frequent and shallow, the skin turns pale.

With ischemic stroke, gradual development of coma is often observed

In some cases, the increase in symptoms can occur very slowly, within several days after the first signs of a stroke appear, so it is important to monitor the patient’s condition around the clock during the first 2-3 days after the stroke.

Factors contributing to prolongation of coma

It is known that the duration of coma is influenced by the extent of the lesion, but there are factors that can lengthen the period of unconsciousness.

These include:

A history of transient ischemic attack or full-blown stroke. The patient's age is over 65 years. The presence of concomitant diseases, especially diabetes and cardiovascular pathologies. Incorrect first aid. How does one recover from a coma?

Coming out of coma is characterized by a gradual restoration of central nervous system functions

Coma recovery occurs gradually, with a slow restoration of lost functions. The order of return is as follows:

Muscle, skin, pharyngeal reflexes. Movements of fingers and limbs. The ability to make sounds and individual words. Restoring vision. Memory restoration. The ability to sit and walk appears.

How many hours or days a coma will last is influenced by many factors, including the speed of first aid. It is important to recognize the onset of a stroke in time and call an ambulance in time.

What remedy for headaches, migraines and stress do many doctors still not know about?!

Do you suffer from occasional or regular headaches? Does it press and squeeze your head, eyes, or does it “hit you with a sledgehammer” on the back of your head, knocking on your temples? Do you sometimes feel nauseous and dizzy when you have a headache? Everything starts to irritate, it becomes impossible to work! Do you take out your irritability on your loved ones and colleagues?

At the beginning of 2017, scientists developed an innovative tool that eliminates all these problems! Civil and military airline pilots are already using this newest remedy to prevent and treat headache attacks, changes in atmospheric pressure, and protection from stress.

and find out about it in a special issue of the program “Live Healthy!” with famous experts.